Anand grover


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Anand grover

  1. 1. Legal Framework in the region: Findings from a legal & policy review of IDU harm reduction in SAARC Anand Grover & Tripti Tandon Lawyers Collective HIV/AIDS Unit, India ‘ Inter-country Consultation on Preventing HIV among IDUs: From Evidence to Action’ 10 –13 April, 2007 Kolkata, India
  2. 2. About the Review <ul><li>Commissioned by UNODC for “Prevention of Transmission of HIV among Drug Users in SAARC Countries ” TD/RAS/2003/H13 </li></ul><ul><li>Objectives : </li></ul><ul><li>(i) Review existing laws & policies on drugs & HIV against risks & responses </li></ul><ul><li>(ii) Suggest way forward; with rights at the core </li></ul><ul><li>Methodology : </li></ul><ul><ul><li>Desk research (International drug conventions, National penal & drug statutes, policies & program reviews on drugs & HIV) </li></ul></ul><ul><ul><li>Site visits (Bangladesh, India, Maldives, Nepal, Pakistan & Sri Lanka) </li></ul></ul><ul><ul><li>Interaction with experts (Officials in drug & HIV depts, Police & Law Officers, NGOs working with IDUs & key pop, UN reps) </li></ul></ul><ul><ul><li>Peer review (Country chapters & draft findings at a Regional Tripartite Review, Mar’06) </li></ul></ul><ul><li>Time Frame : </li></ul><ul><ul><li>Research & Writing 2004-05 </li></ul></ul><ul><ul><li>Peer Review 2005-06 </li></ul></ul><ul><ul><li>Finalised 2006 </li></ul></ul>
  3. 3. Gaps & Limitations <ul><li>Limited access to legal documents i.e statutes/ rules/regulations; no access to judicial decisions </li></ul><ul><li>---- Difficult to ascertain trends in application & interpretation of laws, including use of treatment provisions </li></ul><ul><li>Limited interaction with legal persons; no interaction with lawyers in the field of drugs & HIV </li></ul><ul><li>---- (i)Inability to comment authoritatively on legal system </li></ul><ul><li> (ii)Indicates minimal involvement of legal fraternity in this sector, LC being exception </li></ul>
  4. 4. The Harm Reduction Approach <ul><li>Basis of the report </li></ul><ul><li>Harm Reduction limits negative consequences of certain behaviours w/o necessarily eliminating them </li></ul><ul><li>Offers unconditional services w/o judgment </li></ul><ul><li>Avert immediate harm & pave way out of drug dependence in the long run </li></ul><ul><li>HIV epidemic brought strategy to the forefront </li></ul><ul><li>Applied to other vulnerable groups like MSM, Sex Workers </li></ul><ul><li>Proven efficacy </li></ul><ul><li>Components: NSEP, Drug Substitution & Maintenance, IEC, VCTC, Condoms, STI treatment, HIV/AIDS related treatment, Basic medical treatment, Treatment for drug dependence & Outreach Peer Support </li></ul><ul><li>Founded on individual’s right to health & the integrationist public health approach </li></ul><ul><li>Recognized in international law ( ICESCR ) & enforceable nationally (Constitutions) </li></ul>
  5. 5. Scope of Enquiry: Harm Reduction & the Law <ul><li>Interventions </li></ul><ul><li>Needle/Syringe exchange </li></ul><ul><li>Oral Substitution </li></ul><ul><li>Information on safer sex & drug use </li></ul><ul><li>Condoms </li></ul><ul><li>Peer outreach & support </li></ul><ul><li>Treatment for drug dependence </li></ul><ul><li>Law </li></ul><ul><li>Penal provisions </li></ul><ul><li>Abetment </li></ul><ul><li>Criminal Conspiracy </li></ul><ul><li>Common Intention </li></ul><ul><li>Attempt </li></ul><ul><li>Drug law provisions </li></ul><ul><li>Possession </li></ul><ul><li>Distribution & Supply </li></ul><ul><li>Use/consumption </li></ul><ul><li>Allowing premises to be used for offence </li></ul>
  6. 6. Findings <ul><li>Transition in substance & mode of use – linked to law enforcement ?? </li></ul><ul><li>1990s saw a switch from heroin chasing to pharmaceutical injecting across cities in Bangladesh, India, Nepal & Pakistan </li></ul><ul><li>Transition coincided with legal developments ; </li></ul><ul><li>Eg: In India, supply reduction under the NDPS Act created ‘ heroin droughts ’, hiking street price. Faced with agonizing withdrawal, heroin users sought treatment that included administration of injectable pharmaceuticals. Continued shortage/availability of poor quality heroin led to injecting; a cost effective way of getting ‘high’. Mixing of IDUs with non-injecting users ‘popularised’ injecting </li></ul><ul><li>Studies attribute phenomenon of injecting pharmaceuticals to non-availability of heroin; however links b/w narcotic law enforcement & drug consumption patterns not clearly understood </li></ul><ul><li>Yet, trends indicate that punitive controls do not result in cessation of drug use; on the contrary, have led to riskier patterns of use </li></ul>
  7. 7. Findings <ul><li>Law, policy & practice – evolution & impact </li></ul><ul><li>Across the region: </li></ul><ul><li>Narcotic laws mirror international drug conventions ; penalize inter alia possession, use/consumption & supply </li></ul><ul><li>Despite criminalization of consumption, drug use & dependence seen in every country; IDU & associated HIV reported in four countries </li></ul><ul><li>Narcotic laws contain traditional model of treatment , I.e. detoxification emphasizing abstinence </li></ul><ul><li>In contrast, programs on IDU & HIV have evolved in response to community needs & risks; bringing drug dependent persons in contact with treatment, health & recovery </li></ul><ul><li>HIV policies & to a limited extent, drug policies have come to positively articulate these practices; endorse harm reduction as a public health strategy </li></ul><ul><li>Drug substitution or maintenance may be contemplated in the rubric of treatment of the conventions but not so NSEP or NSP </li></ul>
  8. 8. Findings <ul><li>I. Needle Syringe Exchange Program (NSEP) </li></ul><ul><li>Possession of injection paraphernalia not illegal , except in Sri Lanka </li></ul><ul><li>Provision of needle/syringe illegal ; construed as ‘ abetment ’ of drug consumption, punishable in all jurisdictions </li></ul><ul><li>Programs exist where drug users congregate , which, in turn, are sites for furtive drug activity. Eg: In Lahore, the mobile NSEP is parked at a ‘hot spot’ for peddling, exposing intervention to enforcement action </li></ul><ul><li>Services using Drop In Centres hit by provisions that make “ use of premises for illegal purposes ” punishable </li></ul>
  9. 9. Findings <ul><li>II. Oral Substitution Treatment (OST) </li></ul><ul><li>Historically, the region saw the practice of supplying opium to registered addicts (in absence of treatment for dependence; akin to present day maintenance therapy) </li></ul><ul><li>Presently, all countries prohibit possession, consumption & supply of drugs except when: </li></ul><ul><ul><li>Medically indicated (eg: In Bangladesh, certain drugs can be purchased & consumed for medical use) </li></ul></ul><ul><ul><li>Administered for detoxification (eg: Psychotropic drugs used for de-addiction at govt run/recognised centres in India) </li></ul></ul><ul><ul><li>Necessary to prevent debility or death of user (eg: In Pakistan, law based on Shariat tolerates intoxicants to save life) </li></ul></ul><ul><ul><li>Consumed by a category of persons (eg: Pharmacists in India may dispense drugs to a Foreigner carrying prescription) </li></ul></ul><ul><ul><li>Subject to varying degrees of control & supervision . </li></ul></ul><ul><ul><li>Egs: </li></ul></ul><ul><ul><li>Physicians cannot prescribe narcotics w/o written approval from DNC in Bangladesh </li></ul></ul><ul><ul><li>Only government or licensed institutions can supply to patients in Nepal </li></ul></ul><ul><ul><li>Medical prescription is essential ; w/o which possession & use is punishable </li></ul></ul>
  10. 10. Findings <ul><li>II. Oral Substitution Treatment (OST) cont… </li></ul><ul><li>Methadone & Buprenorphine (most commonly used agents) differentially classified </li></ul><ul><li>Eg: Methadone is a medical drug in Maldives while Buprenorphine is illegal, but classification under Bangladeshi law is quite the opposite </li></ul><ul><li>Treatment options limited ; guided not by clinical outcomes but legal controls </li></ul><ul><li>Eg: OST in India reliant on locally manufactured licit Buprenorphine. Methadone not approved & therefore not available. Import of ‘prohibited’ drugs subject to complex licensing & approval. Sublingual Buprenorphine import awaiting clearance in Bangladesh & Pakistan. </li></ul><ul><li>Provision for substitution open to scrutiny as ‘medical &/or drug treatment’ construed narrowly </li></ul><ul><li>Regulatory mechanisms including licensing, prescription & supervision not in place ; policy makers expressed fear of divergence </li></ul><ul><li>Seen as IDU-HIV prevention measure but not as treatment for opiod dependence </li></ul><ul><li>Eg: Sri Lanka cites low IDU-HIV prevalence for non-provision of OST; overlooking high burden of drug dependence </li></ul>
  11. 11. Findings <ul><li>III. Treatment for drug dependence </li></ul><ul><li>Provided in all country laws except Sri Lanka where offered in prison;outside of law </li></ul><ul><li>Inconsistent approach evident in some countries; </li></ul><ul><li>Eg: Hadd order in Pakistan ordains punishment for users, while CNSA mandates registration & treatment </li></ul><ul><li>Available to ‘ addicts ’ & not first time users </li></ul><ul><li>Routed through penal system e.g: In India, treatment is offered in lieu of prosecution/conviction & not at the first instance </li></ul><ul><li>Conditions attached are unrealistic; failure to comply results in enhanced penalties . E.g: In Maldives, addicts do not enroll in rehabilitation, as unsuccessful treatment results in sentencing </li></ul>
  12. 12. Findings <ul><li>IV. Condoms </li></ul><ul><li>Drug users engaging in unprotected sex with regular & paid partners </li></ul><ul><li>Though accepted as a prevention strategy, provision & use conditioned by social/ legal factors </li></ul><ul><li>Supply in prisons not permitted on a/c of anti-sodomy laws </li></ul><ul><li>V. Information on drug/injection safety </li></ul><ul><li>Identified by outreach teams as necessary to influence drug practices & avoid overdose </li></ul><ul><li>Materials describing ‘ how to inject safely’ construed as aiding/instigating drug use; Eg: Maldives specifically prohibits publications, drawings, posters etc. that generate interest in drugs </li></ul>
  13. 13. Potential ways forward…. <ul><li>To harmonise harm reduction with law, National Governments may : </li></ul><ul><li>Include harm reduction measures within the rubric of medical treatment </li></ul><ul><li>Eg: Govts can exercise rule making powers to notify OST as medical treatment &/or treatment for drug dependence </li></ul><ul><li>Expand scope of Good faith exception </li></ul><ul><li>Eg: Legislature can extend statutory immunity to service providers i.e physicians, outreach workers/NGO staff acting bona fide & in good faith </li></ul><ul><li>Safeguard interventions by Non-obstante clause </li></ul><ul><li>Eg: Legislature can enact overriding clause that protects officially endorsed programs that prevent individual harm & promote public health from criminal & civil liability </li></ul><ul><li>Conduit treatment outside the criminal justice system </li></ul><ul><li>Eg: Legislature can relax rules for diversion; institute provisions that allow users to seek treatment at the first instance rather than during or post trial </li></ul>
  14. 14. Protecting rights of drug users <ul><li>In India, street users are ’soft targets ’ for Police . Eg in Mumbai enforcement action against users has witnessed an increasing trend: </li></ul><ul><li>Year No. of users arrested </li></ul><ul><ul><li>2005 172 </li></ul></ul><ul><ul><li>2006 1002 </li></ul></ul><ul><ul><li>2007 (Jan-Mar) 921 </li></ul></ul><ul><li>In prison, drug users experience precarious health conditions .10 drug users reportedly died in Maharashtra jails b/w Jan & Mar this year alone. Deaths attributable to: </li></ul><ul><ul><li>inappropriate management of withdrawal </li></ul></ul><ul><ul><li>lack of treatment for drug dependence </li></ul></ul><ul><ul><li>Inadequate care & follow up </li></ul></ul><ul><ul><li>HIV related illness </li></ul></ul><ul><li>Since 2005, LC has been providing legal aid to drug users in Arthur Road Jail in association with Sankalp (Rehabilitation) Trust . Till date, 136 clients accessed legal services. </li></ul><ul><li>Like in disability law, it is not necessary to reform the drug user/addict but make the environment enabling and reform the law </li></ul>
  15. 15. Penalty & Prison – who benefits? <ul><li>Among street users, arrest & imprisonment is a pattern : </li></ul><ul><li>Arbitrarily picked up even when not using or in possession of drugs </li></ul><ul><li>Placed in lock-up; investigation influenced with to ‘prove’ consumption </li></ul><ul><li>Charged u/s 27 NDPS Act for unlawful consumption punishable with imprisonment extending to 6months or 1yr </li></ul><ul><li>Not released despite bail for terms, sometimes , longer than the sentence if convitcted; inability to produce surety/personal bond or pay bail amount </li></ul><ul><li>During trial, most plead guilty : </li></ul><ul><ul><li>No legal representation </li></ul></ul><ul><ul><li>Trial period longer than period of sentence </li></ul></ul><ul><ul><li>Have been in jail for period more than sentence </li></ul></ul><ul><li>Incarcerated; Magistrates do not invoke S ec 39 to divert convicted addicts to detoxification & treatment </li></ul><ul><li>Back on streets w/o social or medical assistance, only to be re-arrested </li></ul><ul><li>Vulnerability  arrest  plead guilty since no legal aid  imprisonment  increased vulnerability  release  arrest again  plead guilty again </li></ul><ul><li>REVOLVING DOOR with ‘no benefit’ to user or community </li></ul>